Provider Demographics
NPI:1598059263
Name:LIRA, LIDELIS D (AP & LMT)
Entity Type:Individual
Prefix:MRS
First Name:LIDELIS
Middle Name:D
Last Name:LIRA
Suffix:
Gender:F
Credentials:AP & LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14712 SW 5TH ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027-6113
Mailing Address - Country:US
Mailing Address - Phone:786-352-3844
Mailing Address - Fax:
Practice Address - Street 1:11301 S ORANGE BLOSSOM TRL STE A208
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-9292
Practice Address - Country:US
Practice Address - Phone:407-751-2192
Practice Address - Fax:407-542-2243
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-30
Last Update Date:2020-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA47503225700000X
FLAP3334171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty